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Acute Lymphocytic Leukemia (ALL) is a malignancy that originates from immature lymphoid cells and is clinically established with flow cytometry through disease-specific markers. Variation between ethnic groups is an epidemiological aspect of ALL. Higher incidence rates have been observed in Latin American patients and ALL in Latinos carries a dismal prognosis. The cell of origin in ALL is derived from immature cells of either the B or T lineage. Most reported data among Latinos either exclusively looks at B cell precursor ALL or do not distinguish between subtypes. We used the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to delineate the differences in incidence rates of B-ALL and T-ALL across ethnic groups in the United States. Data from SEER-18 was used to compare incidence rates of T-ALL and B-ALL. Due to the utilization of cytogenetics and subsequent changes in ICD coding over the years examined the most recent data reported from 2002 to 2017. We compared rates in Non-Hispanic Whites (NHWs), Latinos, Blacks and Asian-Pacific Islanders (API). Age-adjusted incidence rates per 100,000 person-years were calculated. The incidence rate of B-ALL in the Latino population was consistently higher than other race/ethnicities throughout the years, ranging from 1.0 per 100,000 in 2002 to 2.5 per 100,000 in 2017. Blacks had the lowest age adjusted incidence rate (AAIR) of B-ALL overall, with rates approximately one third of those found in Latinos and the highest AAIR of T-ALL with an AAIR of 0.5 per 100,000.

In this secondary analysis of Hispanic adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) treated on Cancer and Leukemia Group B (CALGB) 10403, we evaluated outcomes and geographic enrollment patterns relative to US population data. We used demographic, clinical, and survival data on AYAs enrolled on CALGB 10403 (N = 295, 2007-2012). Surveillance, Epidemiology, and End Results registries provided overall survival (OS) for US AYA ALL by ethnicity/race. North American Association of Cancer Registries provided AYA ALL incidence overall and proportion among Hispanics by US state. Of AYAs enrolled on CALGB 10403, 263 (89%) reported ethnicity/race: 45 (17%) Hispanic, 172 (65%) non-Hispanic White (NHW), 25 (10%) non-Hispanic Black (NHB), and 21 (8%) other. Compared with NHWs, Hispanic and NHB patients had lower household income, and Hispanic patients were more likely to harbor high-risk CRLF2 aberrations. Relative to US estimates, where Hispanic patients represented 46% of newly diagnosed AYA ALL patients and experienced inferior OS compared with NHW (P < .001), Hispanic AYAs on CALGB 10403 did as well as NHW patients (3 year OS, 75% vs 74%; P = NS). Hispanic patients also had higher rates of protocol completion (P = .05). Enrollments on CALGB 10403 differed relative to the distribution of Hispanic AYA ALL in the United States: enrollment was highest in the Midwest; t and only 15% of enrollees were from states with a high proportion of Hispanic AYA ALL patients. In summary, Hispanic patients treated on CALGB 10403 did as well as NHWs and better than population estimates. Geographical misalignment between trial sites and disease epidemiology may partially explain the lower-than-expected enrollment of Hispanic AYA ALL patients.

Introduction: Early epidemiological studies of U.S. patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have suggested a possible association between ABO/Rh blood group phenotype and both susceptibility and severity of COVID-19 infection. Given the remarkable heterogeneity of the host inflammatory response in this viral syndrome and the widespread expression of ABO/Rh antigens on vascular and alveolar endothelial cells, it is biologically plausible that certain blood group phenotypes, with their unique repertoire of anti-A and/or anti-B antibodies, may differentially augment the host-pathogen response. We conducted a retrospective review of patients hospitalized for COVID-19 within our regional healthcare network in San Diego County to identify an association between ABO/Rh blood group type and the severity of infection. Methods: All patients hospitalized at one of five Scripps Health hospitals in San Diego County from March 1, 2020 to July 30, 2020 with a PCR confirmed diagnosis of COVID-19 and blood type on record were included in the initial analysis (n = 316). Demographic, laboratory and clinical data were extracted from the electronic medical record and included age, ethnicity, BMI, sex, medications, co-morbidities and admission white blood cell and lymphocyte count, hemoglobin, platelets, ESR, CRP and D-dimer. Outcomes of interest included length of hospitalization, intensive care unit (ICU) admission, mechanical ventilation need, and mortality. Significant associations between each parameter of interest and blood group type were determined using either linear or logistic regression analysis. To address potential confounding variables, an adjusted multivariate model accounting for potential significant (p< 0.1) predictors of each outcome on univariate analysis, in addition to blood type groups, was conducted to further refine any associations. The study was approved by the Scripps Health Institutional Review Board. Results: 316 patients met inclusion criteria for analysis. Hospitalized COVID patients were predominantly male, obese (BMI 30.6) and were an average age of 63 years. Almost 70% of patients hospitalized were Hispanic. 57.0% of patients were blood type O, 30.4% were type A, 3.8% were type B and 8.9% were type AB. 7% were Rh negative. Median length of hospital stay was 16.5±14.7 days, 59% were admitted to the ICU, 37% were intubated, and 27% died. Further relevant laboratory values on admission, co-morbidities, and medications administered during hospitalization are summarized in Table 1. Blood type, with or without adjusting for other clinical variables, was not predictive of length of hospital stay, ICU admission, or intubation during the hospitalization. Type B blood alone was associated with decreased odds of death (OR: 0.27, 95% CI: 0.06-0.85, p0.18). Conclusion: In this large, multi-hospital, retrospective analysis of patients hospitalized for COVID-19 in San Diego County, there was a low relative percentage of Rh negative blood type and type B blood compared to historical population averages. Blood type was not determined to be independently associated with hospital length of stay, mechanical ventilation, ICU admission or death. ABO/Rh blood typing appears to have a limited prognostic role in COVID-19 severity of hospitalized patients, though further analysis of the protective effects of type B and/or Rh negative blood type may be warranted in a larger sample. Disclosures No relevant conflicts of interest to declare.

Higher incidence rates and poor outcomes have been reported among Latin American patients (Latinos) with acute lymphoblastic leukemia (ALL). Distinct patterns in recent genomic studies allude to a predisposing genetic component. In this review, we critically examine the increasing amount of empirical information on the epidemiology, outcomes and genomics of Latinos with ALL. We discuss the immense diversity within the Latino community and varying definitions of what is considered Latino, which pose an epidemiological challenge. Environmental factors have been evaluated as possible predisposing factors in the development of ALL but studies have produced conflicting results. In this review we describe chromosomal abnormalities and the specific genomic landscape in Latinos with ALL and their association with unfavorable prognosis, focusing on the higher frequency of Philadelphia chromosome-Like ALL. Recent data suggest an association between polymorphisms that are commonly found in indigenous Americans and high rates of ALL. The review compares the distribution of ALL throughout the various countries in Latin America in an attempt to shed some epidemiological light on the genetic ancestry of ALL. We additionally identify areas where research is warranted in efforts toward the advent of novel targeted agents that are relevant in improving outcomes within the Latino community.

Historically, patients with locally advanced or metastatic melanoma have an extremely poor prognosis. In recent years, major breakthroughs in cutaneous melanoma treatment have led to remarkable improvements in patient outcomes. However, there are limited published data on the efficacy of these novel therapies in the treatment of mucosal melanoma due to rarity of the disease. We report a case of successful neoadjuvant targeted therapy with BRAF and MEK inhibitors followed by radical surgical excision in a patient with advanced malignant melanoma of the gallbladder.

Fostering urban resilience requires a social-ecological systems approach that considers the ecological and social feedbacks of cities. In this paper we argue that Urban Ecosystem Services (UES) could increase urban resilience; and that resilient UES depends directly on the quantity, quality and diversity of the green infrastructure that produces them. The case of the western boundaries of Mexico City is used to map and assess these issues. We classified the different settings of green infrastructure as Service Providing Units (SPUs) and identified their provision of UES through remote sensing techniques; the Normalized Difference Vegetation Index (NDVI) combined with fieldwork verification in two scales of analysis, the local and regional. The results reveal that the vast majority of green infrastructure has low quality, hindering the provision of the UES required for building Mexico City´s resilience. At the regional scale, the growing pressures of urban development and the consequent reduction of SPUs threatens the delivery of provisioning ecosystem services while at the local scale, the low quality of SPUs threatens the provision of regulating ecosystem services. We argue that addressing these challenges could improve the design and implementation of environmental decision-making and urban policy towards more resilient urban social-ecological systems.

Primary cardiac lymphoma (PCL) is a rare condition described as a lymphoma localized to the heart or pericardium. Although cardiac involvement is seen in 10–20% of non-Hodgkin’s lymphomas, PCL is extremely rare. It comprises merely 0.5% of all lymphomas and 1.3–2% of cardiac malignancies. Early detection is essential to avoid potentially fatal complications, and prognosis is highly dependent on the management of cardiac complications. The etiology of PCL is still unknown, and molecular characterization has yet to be studied leaving a great deal of research to be done in order to gain a better understanding of this rare disease process. We discuss the case of an 85-year-old female presenting with dyspnea and chest pain. Computed tomography of the chest revealed a pericardial effusion, and subsequent echocardiogram demonstrated a large circumferential effusion. She underwent emergent pericardiocentesis. Morphologic and immunophenotypic features were consistent with high-grade B-cell lymphoma with t8;14, and the patient was started on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with excellent response.

Introduction: An interesting epidemiological aspect of ALL is the variation between ethnic groups. Among all subtypes of leukemia Latinos have lower incidence rates. However, in remarkable contrast, ALL has a higher incidence rate in the Latino population and also carries a more dismal prognosis (Barrington-Trimis J, et al Blood 2015). The majority of reported data among Latinos either exclusively looks at B cell precursor (BCP) ALL or does not distinguish between subtypes. In this study we used the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to delineate the differences in incidence rates of B-ALL and T-ALL across ethnic groups in the United States. Epidemiologically, highest rates of ALL worldwide have been reported in both adult and pediatric Latino patients. However, determining who is to be considered Latino is not always straightforward. Many studies utilize self reported ethnicity and databases such as the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI) employ complex algorithms to determine ethnicity. Of note, the North American Association of Central Cancer Registries (NAACCR) Hispanic Identification Algorithm (NHIA) used by SEER includes European Spaniards but excludes South American Brazilians. This is a point of special interest due to the fact that although the overall incidence of ALL in the Brazilian population is low, the regional distribution is strikingly heterogeneous, with higher rates in regions with higher indigenous ancestry. Methods: Data from the SEER-18 database was used compare incidence rates of T-ALL and B-ALL. Patients in which ethnicity was reported were included. Due to the utilization of cytogenetics and subsequent changes in ICD coding over the years we chose to look at the most recent data reported in 2014. We compared rates in non-Hispanic Whites, Latinos (Hispanic), Blacks and Asian-Pacific Islanders (API). Age-adjusted incidence rates per 100,000 person-years were calculated. Results: AAIR of B-ALL in the Hispanic population is consistently higher than that of Non-Hispanic Whites throughout the years, ranging from 1.0-2.4 per 100,000. Blacks had the lowest incidence overall, with rates approximately one third of those found in Latinos. The distribution of ALL throughout the Americas can perhaps shed some epidemiological light on the genetic origins of ALL in Latinos. The ancestry across Latin America is mixed but historical idiosyncrasies can perhaps explain the distribution of ALL in the Americas. We reviewed the available literature and found that throughout the Americas, higher incidence rates are seen in areas of higher Native American ancestry (Fig 1). Discussion: Our finding shows that the increase of ALL among Latinos is accounted for by the high rate of B cell origin. The increased incidence of ALL in the Latino population has been linked to polymorphisms in genes such as the transcription factor GATA3 (Perez-Andreu V, Nat Genet 2013). The underlying mechanism of disease has yet to be elucidated and is likely related to BCP- ALL and, more specifically, Ph-Like ALL. This variation appears to be related to Native American ancestry. Understanding the molecular mechanism and epidemiological origins of this subset of patients with aggressive features will lead to improved treatment and overall survival in this minority healthcare disparity. Figure 1. Figure 1. Disclosures Douer: Shire: Membership on an entity's Board of Directors or advisory committees; Gilled Sciences, Inc: Consultancy; Spectrum: Consultancy; Jazz Pharmaceuticals: Consultancy; Amgen: Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria.

Introduction: Acute Lymphoblastic Leukemia (ALL) is divided into Pre-B and T phenotypes depending on the progenitor cell giving rise to the malignant clone. This disease is the most common cancer in children while rare in adults. Interestingly, higher incidence rates and poorer outcomes have been reported in patients of Latin American ethnicity. This has been attributed to higher rates of Philadelphia-Like (Ph-like) ALL and increased incidence of high risk features such as absence of hyperdiploidy and absence of t(12;21). The current data among Latinos either exclusively looks at B cell precursor (BCP) ALL or does not distinguish between subtypes. Our study sets out to better define the phenotype of this subset of patients with traditionally poor outcomes. Methods: Our database consisted of 825 adult patients (ages 18-85 years) diagnosed with ALL from the City of Hope Comprehensive Cancer Center in Los Angeles, California. The population in Southern California has a particularly high number of Latinos due to its proximity to Mexico and Central America. According to the 2017 United States Census, 48.6% of the Los Angeles population is of Hispanic or Latino origin. Age at diagnosis, initial WBC count, CNS involvement, imumnophenotype, cytogenetics and rate of hematopoietic cell transplantation during therapy were assessed between ethnic groups. Multivariable Logistic Regression was done to determine the features that distinguish Latino patients for Non-Hispanic Whites. Results: 57.4% of the patients were Latinos and 42.6% were Non-Hispanic Whites (NHWs), a distribution unique to the Los Angeles area and consistent with US census population data. BCP ALL was more common in Latinos when compared to NHWs with a Hazard Ratio of 5.13 (95% CI between 2.97-8.87). The presence of the t(9;22) or Philadelphia chromosome (Ph+) was more common in NHW patients. The Hazard Ratio for Ph+ ALL in NHWs was 0.53 (95% CI between 0.37-0.77) CNS involvement was more common in Latino patients and MLL was the only cytogenetic abnormality less common in NHWs. Normal Karyotype (NK), Complex and Others were all more common in Latino patients. No difference was found between WBC counts of Latinos and NHW. (Fig. 1). Discussion: ALL has been shown to have higher rates in the Latino population. Our results among adults ages 18-85 years old, demonstrated that this difference can be attributed to higher incidence of BCP ALL and not T-cell among Latinos. This is consistent with the previously reported higher rate of Ph-Like ALL and distinct molecular aberrations among Latinos. Our data shows that the rate of Ph+ ALL is higher in NHWs when compared to Latinos. This is a very interesting finding as the presence of Ph+ ALL and Ph-like ALL are mutually exclusive. Associations have been previously reported between Ph-like ALL and Latin American ethnicity. Although there are types of ALL that are neither Ph+ nor Ph-like this finding suggests a higher incidence of Ph-like ALL in Latinos. At the present time, standard cytogenetics do not include CRLF2, IKZF1 and other mutations found in Ph-like ALL. Complex cytogenetics and CNS involvement, both factors associated with poor prognosis, are most likely to present in a Latino patient. While the precise mechanism is unknown, our findings further support the hypothesis that a unique genetic fingerprint has led to development and outcomes of Ph-like ALL in Latinos. It is evident that this subset of unfavorable BCP ALL population needs special attention. More studies are imperative to further elucidate the mechanism behind Ph-like ALL and pinpoint the risk factors in the Latino population. Disclosures Douer: Spectrum: Consultancy; Amgen: Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria; Jazz Pharmaceuticals: Consultancy; Gilled Sciences, Inc: Consultancy; Shire: Membership on an entity's Board of Directors or advisory committees.

HIV is known to infect cells in the brain causing neurological impairments. Damage ranges from mild (HAND) to severe (HAD). We found learning impairment in rats infused with astrocytes expressing N...

CONTEXT Chronic Lymphocytic Leukemia (CLL) is a clonal proliferation of small mature B-cell lymphocytes diagnosed clinically when the peripheral blood clonal B lymphocyte count is persistently >5,000/mcL with distinctive immunological markers defined by co-expression of CD5 and CD23 with additional expression of CD19, CD20 (weak) with weak surface immunoglobulin expression, usually IgM heavy chain. Expression of CD79b and FMC7 is typically negative to weakly positive. With the recent advancement in cancer genetics and the continued understanding of the transforming events in CLL, the importance of the various somatic genomic aberrations has been well documented. Multiple studies have shown the clinical implications of these aberrations in terms of their prognostic and predictive relevance in clinical practice and these genomic aberrations are usually assessed clinically by cytogenetic analysis and FISH. OBJECTIVE We proposed this study to determine the incidence of the genomic aberrations in the CLL patients diagnosed at the Rose Cancer Treatment Center of the William Beaumont Hospital between 2010 and 2015 and to determine their impact on survival among the patients diagnosed during the study period. STUDY DESIGN A retrospective review of all the patients diagnosed with CLL between 2010 and 2015 at the Rose Cancer Treatment Center was conducted with the assistance of the staff in the William Beaumont cancer registry office. We determined the demographic variables and analyzed the incidence of CLL among the subjects diagnosed within the study period. Data analysis was performed using SPSS 21 and Kaplan-Meier curves were plotted for survival analysis and log rank (Mantel-Cox) was used to compare these curves. 12-Month and 36-Month overall survival rates were analyzed by actuarial method. The distribution of the various genomic aberrations was determined using descriptive statistical analysis. RESULTS A total of 151 patients were identified at the Rose Cancer Center of the William Beaumont Hospital during the study period. The median age at diagnosis was 74 years (range 38-101) of which 90 were male (59.6%) and 61 female (40.4%). One-hundred and twenty-four (82.1%) patients were white, six patients (4.0%) were African American, two patients (1.3%) were Asian and nineteen (12.6%) patients declined to identify their race. Analysis of cytogenetic distribution showed that, twenty patients (13.2%) had normal cytogenetic, eleven patients (7.3%) had del(13q) alone, eight (5.3%) had both del(13q) and del(11q), four patients (2.6%) had del(13q) plus trisomy 12 aberrations, ten (6.6%) patients had del(13q) and other karyotypes (TP53, RB1, trisomy 1q, del(6q23), unmutated IGHV). Thirteen patients (8.6%) had trisomy 12 abnormality, five patients (3.3%) had del(11q), three patients (2.0%) had del(17p), twenty-five patients (16.6%) had complex cytogenetic abnormalities and fifty-two (34.4%) patients cytogenetic were not checked (see Fig.1). The median follow-up duration for the cohort was 22.5 months (range 0 to 70 months). The survival rates at 12 months and 36 months for the cohorts based on cytogenetic are described in table 1 and fig.2. CONCLUSION Our study showed that majority of our patients (34.4%) did not have their cytogenetics checked at diagnosis, patients with del(13q) abnormality alone had the most favorable 36-Month overall survival rate and those with del(17p) fared worst with the most unfavorable outcome followed by patients with complex cytogenetic abnormalities. Presence of del(13q) with either del(11q) or trisomy 12 abnormalities appeared to ameliorate their poor and intermediate adverse prognostic effects, respectively. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.